Sign up for more information about your condition and HUMIRA.

At this time, only people on or starting treatment with HUMIRA are eligible to enroll in HUMIRA Complete. If you are considering HUMIRA, continue to the sign-up form below to receive updates about HUMIRA and your condition.

Start your enrollment.

With HUMIRA Complete, you’ll get access to the resources you need, when you need them. HUMIRA Complete resources include:

HUMIRA Complete Savings Card

Injection Training Kit

Medication Reminders

Sharps Container and the Sharps Mail-Back Disposal Kit

Insulated Cooler Bag

Once enrolled, you’ll get a call from an Ambassador*, whose first priority is to help you with your treatment plan.

*Nurse Ambassadors do not give medical advice and will direct you to your health care professional for any treatment-related questions, including further referrals.

We ask for your start date so that your Nurse Ambassador can get to know you better and provide you with a more personalized treatment experience.

What condition are you diagnosed with?

Please note: To enroll in HUMIRA Complete, you must be taking HUMIRA for a condition that is FDA approved for treatment. If you are taking HUMIRA for other diagnoses, please call 1.800.4HUMIRA (1.800.448.6472) for assistance.

Moderate to Severe Rheumatoid Arthritis

Moderate to Severe Chronic Plaque Psoriasis

Moderate to Severe Crohn’s Disease

Moderate to Severe Pediatric Crohn’s Disease

Moderate to Severe Ulcerative Colitis

Psoriatic Arthritis

Moderate to Severe Hidradenitis Suppurativa

Ankylosing Spondylitis

Moderate to Severe Polyarticular Juvenile Idiopathic Arthritis

Non-Infectious Uveitis Intermediate, Posterior, and Panuveitis

Your Date of Birth

MM/DD/YYYY

You must be 18 years of age or older to enroll in HUMIRA Complete.

Your Gender

Male

Female

You must be the child's legal guardian and 18 years of age or older to enroll in HUMIRA Complete on behalf of the child.

I am the child's legal guardian and am 18 years of age or older.

Patient's First Name

Patient's Last Name

Patient's Date of Birth

MM/DD/YYYY

We ask for the patient’s date of birth so that your Nurse Ambassador can get to know the patient better and provide you with a more personalized treatment experience.

Patient's Gender

Male

Female

Check your eligibility for the HUMIRA Complete Savings Card.

What kind of health insurance coverage do you have?

Private/Commercial*

Government-provided**

I am not insured

Your insurance information will be used to determine your eligibility for the HUMIRA Complete Savings Card.

*Health insurance you or a family member purchased privately or through an employer.

Your contact information.

This will be your username when you log in to HUMIRA Complete. Be sure to record this information, including your password, and keep it in a safe place.

Create a password

Your password must be between 8 and 16 characters and contain an uppercase character, a lowercase character, a number, and a non-alphanumeric character (e.g., !@#$%^&*()-|).

Strength

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Show Password

As part of HUMIRA Complete, you can easily log in with just your email and password to access all your available resources.

Phone Number

Your phone number will be used only to provide assistance with this program.

Please leave messages at this number.

ZIP Code

Your ZIP Code will be used only to provide assistance with this program.

Receive updates about HUMIRA and your condition.

In order to be eligible to enroll in HUMIRA Complete, you must indicate that you are either taking or starting on treatment with HUMIRA for at least one of the approved conditions below:

What condition are you diagnosed with?

Moderate to Severe Rheumatoid Arthritis

Moderate to Severe Chronic Plaque Psoriasis

Moderate to Severe Crohn’s Disease

Moderate to Severe Pediatric Crohn’s Disease

Moderate to Severe Ulcerative Colitis

Psoriatic Arthritis

Moderate to Severe Hidradenitis Suppurativa

Ankylosing Spondylitis

Moderate to Severe Polyarticular Juvenile Idiopathic Arthritis

Non-Infectious Uveitis Intermediate, Posterior, and Panuveitis

What type of doctor(s) are you seeing to treat your condition above? (Check all that apply.)

Rheumatologist

Dermatologist

Gastroenterologist

Pediatric Rheumatologist

Pediatrician

Primary Care Physician

Ophthalmologist

Are you currently taking any medicines to treat your condition?

Yes

No

Currently taking (Check all that apply.)

Amevive® (alefacept)

Cimzia® (certolizumab pegol)

Enbrel® (etanercept)

Methotrexate

Orencia® (abatacept)

Remicade® (infliximab)

Rituxan® (rituximab)

Tysabri® (natalizumab)

Other prescription drugs

All trademarks are properties of their respective companies.

Have you previously taken any medication to treat your condition?

Yes

No

Previously taken (Check all that apply.)

Amevive® (alefacept)

Cimzia® (certolizumab pegol)

Enbrel® (etanercept)

Methotrexate

Orencia® (abatacept)

Remicade® (infliximab)

Rituxan® (rituximab)

Tysabri® (natalizumab)

Other prescription drugs

All trademarks are properties of their respective companies.

You must be 18 years of age or older to sign up for updates about your condition and HUMIRA.

I am 18 years of age or older.

You must be the child's legal guardian to receive materials on the child's behalf.

I am the child's legal guardian.

Your contact information.

Your First Name

Your Last Name

Your Email Address

This will be your username when you log in to HUMIRA Complete. Be sure to record this information, including your password, and keep it in a safe place.

Street Address

Street Address 2 (optional)

City

State

ZIP Code

Your ZIP Code will be used only to provide assistance with this program.

Phone Number

Your phone number will be used only to provide assistance with this program.

Please leave messages at this number.

I authorize AbbVie and its partners to use, disclose, and/or transfer the personal information I supply about myself and the patient (1) to contact me and provide me and the patient with informational and marketing materials and clinical trial opportunities related to the patient’s condition or treatment by any means of communication, including but not limited to text, e-mail, mail, or telephone; (2) to help AbbVie improve, develop, and evaluate products, services, materials, and programs related to the patient’s condition or treatment; (3) to enroll the patient in and provide the patient with HUMIRA related programs and services that I may select or refuse at any time; (4) to disclose the patient’s enrollment and use of these services to the patient’s health care providers and insurers; and (5) to use the patient’s information that cannot identify the patient for scientific and market research.

To cancel or request a copy of this authorization, please contact us at 1.800.888.6260. I understand that if I cancel, the patient may not be entitled to receive HUMIRA related programs and services.

By clicking Sign Up Now, I agree to the statements above. I also represent that I am the patient’s legal custodial parent or an authorized personal representative of the patient under applicable state law. If the patient is an unemancipated minor (generally, under 18 years of age) or otherwise does not have the capacity to enroll himself or herself into the program, the patient’s legal custodial parent or other authorized personal representative may sign the enrollment form on behalf of the patient. Only certain individuals may qualify as the patient’s personal representative (for example, an individual with a health care power of attorney or a legal guardian). State law prescribes who can be a personal representative.

I am entitled to receive a copy of my authorization and I am aware the AbbVie Privacy Statement is available at www.abbvie.com/privacy.html.

I authorize AbbVie and its partners to use, disclose, and/or transfer the personal information I supply (1) to contact me and provide me with informational and marketing materials and clinical trial opportunities related to my condition or treatment by any means of communication, including but not limited to text, e-mail, mail, or telephone; (2) to help AbbVie improve, develop, and evaluate products, services, materials and programs related to my condition or treatment; (3) to enroll me in and provide me with HUMIRA related programs and services that I may select or refuse at any time; (4) to disclose my enrollment and use of these services to my healthcare providers and insurers; and (5) to use my information that cannot identify me for scientific and market research.

To cancel or request a copy of this authorization, please contact us at 1-800-888-6260. I understand that if I cancel I may not be entitled to receive HUMIRA related programs and services.

By clicking Sign Up Now, I agree to the statement above.

I am entitled to receive a copy of my authorization and I am aware the AbbVie Privacy Statement is available at www.abbvie.com/privacy.html.